Helping Medical Students Feel at Home in Rural Healthcare

As rural communities nationally face a shortage of primary-care physicians, a mentorship and education program attracts new physicians to underserved parts of western North Carolina.

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Brittany Papworth, a UNC School of Medicine student finishing her third year at the school’s Asheville campus, never considered rural medicine as a career path. But a medical training program in western North Carolina helped Papworth see rural healthcare in a new light.

Now she’s focusing on rural medicine and finds it’s a good fit with her desire to “do “grassroots work with a strong focus in public health and community advocacy.”

MAHEC residency training programs have graduated 466 physicians and dentists, many of whom stay in western North Carolina to become family doctors and community leaders. Since its inception, MAHEC has successfully retained 65% of its family medicine graduates in the state of North Carolina and 60% have chosen to practice in the western part of the state.

Still, a 2014 study by Mission Health showed the 16-county region is short at least 140 family medicine doctors.

The success of MAHEC’s recruitment of physicians starts as early as high school and exposes young people to rural physicians and mentors at every educational level along the way.

“Learning opportunities at the medical school, undergraduate and high school level fuel students’ passion and vision for medicine,” said Dr. Jeff Heck, president and CEO of MAHEC. “Our goal is consistently to increase the number of people pursuing rural health careers in [western North Carolina]. Personal and professional mentorships become an enormous influence helping students direct their path to rural medicine.”

MAHEC faculty provides leadership for the UNC Kenan Primary Care Scholars program, which immerses medical students in rural community practices to mentor and encourage them as future physicians. In the summer between the students’ first and second year of medical school, these medical students live and work in a rural community in western North Carolina.

Margaret Pray spent her summer at the Tallulah Health Center in Robbinsville, North Carolina, the only primary care center in Graham County. This mountainous county lies just southwest of the Great Smoky Mountains National Park. With 8,600 residents and a poverty rate 20 percent higher than the state average, the county has only 3.4 physicians per 10,000 residents – far behind the state average of 21.5 doctors.

Pray, who does not have a small town upbringing, said the experience of living and working in a rural county was significant.

“It was kind of a test for me to make sure that this was something that really fit my lifestyle,” Pray said. “It was really special to see this tiny town just kind of adopt me.”

She said her six weeks in the county showed her she could be at home in a rural community.

Primary care scholars attend monthly enrichment sessions about rural healthcare during their second year of medical school. In the third and fourth years, they gain exposure to underserved patients – a particular focus of MAHEC –through a partnership with a local non-profit organization. The nonprofit’s clientele includes uninsured patients, some of whom face challenges such as homelessness, previous incarceration, or drug dependency.

Medical student Brittany Papworth said her through MAHEC at a rural clinic helped her better understand rural patients and some of their needs.

Medical student Brittany Papworth said her experience at the local clinic was eye opening.

“The visual of someone waiting in line outside of a medical clinic to get medical care was shocking,” she said. “To be able to have that experience, which is extremely unique in medical school, is extremely fulfilling, and something that will help me moving forward.”

Papworth recalled caring for a woman in her 40s who was extremely underprivileged. “[The patient] said she had never trusted the medical system because she felt like she was marginalized, and because of her past with drugs, she felt no doctor would ever trust her,” Papworth said. “As a medical student, I had the luxury of spending a lot of time with her, talking with her about everything — her kids, her husband, her grandchildren. I think being able to do that and growing closer to her was really awesome and having her say, ‘I’m so grateful that someone listened,’ was better than any medicine we could have offered her, which wasn’t much.”

Training and residencies in settings are keys for recruiting rural doctors, according to a 2013 study by the Robert Graham Center for Policy Studies. The study found that 65% of physicians stay within 100 miles of their residency training. National data shows that graduates from rural residency programs are three times more likely to practice in rural areas than urban residency program graduates, according to a 2010 article in the Family Medicine journal.

Nationally, only 9% of U.S. physicians practice in rural areas. This year MAHEC graduated 13 family medicine physicians. Seven have elected to practice in a rural community.